The empathic brain and its dysfunction in psychiatric populations: implications for intervention across different clinical conditions

Empathy is a concept central to psychiatry, psychotherapy and clinical psychology. The construct of empathy involves not only the affective experience of the other person's actual or inferred emotional state but also some minimal recognition and understanding of another's emotional state. It is proposed, in the light of multiple levels of analysis including social psychology, cognitive neuroscience and clinical neuropsychology, a model of empathy that involves both bottom-up and top-down information processing underpinned by parallel and distributed computational mechanisms. The predictive validity of this model is explored with reference to clinical conditions. As many psychiatric conditions are associated with deficits or even lack of empathy, we discuss a limited number of these disorders including psychopathy/antisocial personality disorders, borderline and narcissistic personality disorders, autistic spectrum disorders, and alexithymia. We argue that future clinical investigations of empathy disorders can only be informative if behavioral, dispositional and biological factors are combined

An interoceptive predictive coding model of conscious presence

We describe a theoretical model of the neurocognitive mechanisms underlying conscious presence and its disturbances. The model is based on interoceptive prediction error and is informed by predictive models of agency, general models of hierarchical predictive coding and dopaminergic signaling in cortex, the role of the anterior insular cortex (AIC) in interoception and emotion, and cognitive neuroscience evidence from studies of virtual reality and of psychiatric disorders of presence, specifically depersonalization/derealization disorder. The model associates presence with successful suppression by top-down predictions of informative interoceptive signals evoked by autonomic control signals and, indirectly, by visceral responses to afferent sensory signals. The model connects presence to agency by allowing that predicted interoceptive signals will depend on whether afferent sensory signals are determined, by a parallel predictive-coding mechanism, to be self-generated or externally caused. Anatomically, we identify the AIC as the likely locus of key neural comparator mechanisms. Our model integrates a broad range of previously disparate evidence, makes predictions for conjoint manipulations of agency and presence, offers a new view of emotion as interoceptive inference, and represents a step toward a mechanistic account of a fundamental phenomenological property of consciousness

fMRI exploration of the cerebral mechanisms of the perception of pain in others via facial expression

La douleur ressentie entraine des réactions de différents ordres : physique, neurologique, comportemental. L’expression de la douleur sur un visage constitue une de ces réactions, d’ordre comportemental. Cette expression faciale intègre les éléments caractérisant la douleur ressentie et il est possible de l’analyser en tant qu’observateur extérieur. Les travaux d’imagerie cérébrale étudiant la réaction du cerveau à la perception d’une douleur chez autrui ont mis en lumière un chevauchement entre les régions du cerveau réagissant à une douleur personnellement ressentie et celles réagissant à l’observation d’une expression de douleur chez les autres. Dans la première étude présentée ici, la réaction du cerveau à l’expression de la douleur chez autrui a été analysée en établissant dans quelle mesure l’intensité plus ou moins forte de la douleur exprimée pouvait moduler cette réaction. Les résultats de cette étude indiquent que la perception de la douleur chez autrui ne concerne pas seulement certaines régions du cerveau réagissant à la douleur personnellement ressentie mais aussi des régions habituellement impliquées dans le système des neurones miroirs (MNS; « human mirror neuron system ») ainsi que dans des régions associées à la Théorie de l’esprit (‘Theory of Mind’, ToM; ou « mentalizing »). En outre, ce travail montre que l’implication relative de ces différentes régions varie selon que la personne évalue la signification affective de l’expression – la magnitude de la douleur – ou qu’elle discrimine les composantes motrices de l’expression – les mouvements faciaux. Une deuxième étude a donc été réalisée, s’appuyant sur un paradigme combinant l’observation et l’exécution pour vérifier et confirmer la « réponse miroir » observée dans la première étude et pour examiner plus en détail les différences apparentes entre la résonance émotionnelle et la résonance motrice. En confirmation de la première étude, il a été établi que ce sont différentes régions du cerveau qui sont impliquées dans les réactions à l’expression de la douleur selon qu’elles relèvent de la résonance émotionnelle ou de la résonance motrice. En somme, ces résultats montrent que la perception de la douleur chez autrui est un processus complexe qui met en jeu un chevauchement entre les régions réagissant à une douleur personnellement ressentie et à une douleur constatée chez autrui, ainsi que les phénomènes de résonance motrice (« mirroring ») et de « mentalizing », processus plus généraux de la cognition sociale.The pain experience provokes several responses – physical, neural, behavioral. The facial expression of pain is one such behavioral response: it encodes the subjective experience of pain and, as observers, we can decode it. Neuroimaging studies looking at the brain response to the perception of pain in others have identified overlap between brain areas active for the experience of self-pain, and those active during the observation of pain in others. In the first study described below, the brain response to pain in others was investigated using a paradigm that investigated how the intensity of the perceived pain modulated the brain response. The results of this work indicate that the perception of pain in others involves not only certain brain regions involved in self-pain, but also regions previously implicated in the human mirror neuron system (MNS), as well as areas underlying Theory of Mind (i.e. mentalizing). Further, the relative contribution of these areas depended on whether the subject is evaluating the affective meaning of the expression – the pain magnitude – or if they are discriminating the motor components of the expression – the facial movements. A second study was thus designed, using a combined observation and execution paradigm, to confirm the mirroring response observed in the first study, as well as to further explore the hypothesized difference between emotional and motor mirroring. Similarly to the first study, it was found that different brain regions are responsible for mirroring for emotional, versus motor, content of the observed pain expressions. Taken together, these results reveal the perception of pain in others to be a complex process that involves overlap between self and other affective pain areas, as well as mirroring and mentalizing – more general processes of social cognition

Neurofeedback with fMRI: A Critical Systematic Review

Neurofeedback relying on functional magnetic resonance imaging (fMRI-nf) heralds new prospects for self-regulating brain and behavior. Here we provide the first comprehensive review of the fMRI-nf literature and the first systematic database of fMRI-nf findings. We synthesize information from 99 fMRI-nf experiments—the bulk of currently available data. The vast majority of fMRI-nf findings suggest that self-regulation of specific brain signatures seems viable; however, replication of concomitant behavioral outcomes remains sparse. To disentangle placebo influences and establish the specific effects of neurofeedback, we highlight the need for double-blind placebo-controlled studies alongside rigorous and standardized statistical analyses. Before fMRI-nf can join the clinical armamentarium, research must first confirm the sustainability, transferability, and feasibility of fMRI-nf in patients as well as in healthy individuals. Whereas modulating specific brain activity promises to mold cognition, emotion, thought, and action, reducing complex mental health issues to circumscribed brain regions may represent a tenuous goal. We can certainly change brain activity with fMRI-nf. However, it remains unclear whether such changes translate into meaningful behavioral improvements in the clinical domain

Intrinsic Shapes of Empathy: Functional Brain Network Topology Encodes Intersubjective Experience and Awareness Traits

Trait empathy is an essential personality feature in the intricacy of typical social inclinations of individuals. Empathy is likely supported by multilevel neuronal network functioning, whereas local topological properties determine network integrity. In the present functional MRI study (N = 116), we aimed to trace empathic traits to the intrinsic brain network architecture. Empathy was conceived as composed of two dimensions within the concept of pre-reflective, intersubjective understanding. Vicarious experience consists of the tendency to resonate with the feelings of other individuals, whereas intuitive understanding refers to a natural awareness of others’ emotional states. Analyses of graph theoretical measures of centrality showed a relationship between the fronto-parietal network and psychometric measures of vicarious experience, whereas intuitive understanding was associated with sensorimotor and subcortical networks. Salience network regions could constitute hubs for information processing underlying both dimensions. The network properties related to empathy dimensions mainly concern inter-network information flow. Moreover, interaction effects implied several sex differences in the relationship between functional network organization and trait empathy. These results reveal that distinct intrinsic topological network features explain individual differences in separate dimensions of intersubjective understanding. The findings could help understand the impact of brain damage or stimulation through alterations of empathy-related network integrity